Exploring the facilitators and barriers in opioid deprescribing for non-cancer pain treatment experienced by general practitioners: A qualitative study.

Publisher: Wiley Country of Publication: England NLM ID: 9801774 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2149 (Electronic) Linking ISSN: 10903801 NLM ISO Abbreviation: Eur J Pain Subsets: MEDLINE

Publication: 2012- : Chichester, UK : Wiley
Original Publication: London ; Philadelphia : Saunders, c1997-

Analgesics, Opioid*/therapeutic use ; Deprescriptions* ; General Practitioners*/psychology ; Qualitative Research* ; Chronic Pain*/drug therapy ; Focus Groups* ; Pain Management*/methods; Humans ; Male ; Female ; Netherlands ; Middle Aged ; Attitude of Health Personnel ; Adult ; Opioid-Related Disorders/drug therapy ; Practice Patterns, Physicians'/statistics & numerical data ; Primary Health Care ; Patient-Centered Care

Background: Guidelines recommend opioid deprescribing in patients on long-term opioid treatment for chronic non-cancer pain. This study aims to explore facilitators and barriers in opioid deprescribing among general practitioners in the Netherlands. In addition, this study aims to identify possibilities for improvement regarding opioid deprescribing in primary care.
Methods: Focus group discussions with Dutch General practitioners were held by two skilled moderators. The focus group discussions were transcribed verbatim and analysed using MAXQDA software. Three independent reviewers searched for overarching themes using thematic analysis with an inductive approach. Discussions were organized until data saturation was reached.
Results: Twenty-two general practitioners participated in four focus group discussions. Five main themes emerged from the data: (1) patient-centred care; (2) ensuring proper pain management (3) dilemmas and hardships in dealing with opioid use disorder; (4) the competency gap; (5) needs and possibilities to improve opioid deprescribing in primary care. The first theme addresses the main facilitators in opioid tapering. The following three themes emerged as main barriers in opioid deprescribing. The fifth theme identified possibilities for change.
Conclusions: This study indicates the importance of intrinsic motivation and a tailored approach to deprescribe opioids in patients with chronic pain on long-term opioid treatment. Identified barriers include struggles in pain management, challenges caused by opioid use disorder, insufficient capacities such as time constraints and lack of skills. Recommendations for improvement involve enhanced collaboration with healthcare professionals in primary and secondary care, provision of practical tools and assurance of sufficient time.
Significance: This focus group study among 22 Dutch general practitioners elucidates the complexities of opioid deprescribing and reveals pivotal themes such as patient-centred care, pain management challenges, and competency gaps. The findings underscore the crucial role of intrinsic motivation and that of a tailored approach in opioid deprescribing, while demonstrating how a lack in effective pain treatments, practical capacities and challenges caused by opioid dependence, impede opioid deprescribing. By uncovering these complexities, this study aims to inform future deprescribing strategies.
(© 2024 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

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0 (Analgesics, Opioid)

Date Created: 20240130 Date Completed: 20240724 Latest Revision: 20240724

20240725

10.1002/ejp.2243

38287911